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Head drop and camptocormia
  1. A D Macleod
  1. Psychiatric Consultation Service, Christchurch Hospital, Private Bag 4710, Christchurch, New Zealand; PCS{at}cdhb.govt.nz
    1. T Umapathi
    1. Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, 308433 Singapore; tumapathi{at}yahoo.com

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      The article by Umapathi et al1 in this journal referred to the original use of the term camptocormia by Souques in 1915,2 though functional bent back was first described by Brodie in 1837. Mlle Rosanoff-Saloff supported Souques’ case study with a photographic record of this soldier’s bent back and his recovery. According to the English translation abstract in Southard’s fine collection of shell shock cases3 this soldier was wounded five months previously by a bullet that entered along the auxiliary border of the scapula and emerged near the spine. “He spat blood for several days ... and when he got up his trunk and thighs were found to be in a state of moderate flexion upon the pelvis, the trunk being bent almost at a right angle.” He was able to bend his trunk still further forward than ‘its habitual contractured position’ and it was evident that there was contraction of the muscles of the abdominal wall and of the iliopsoas. “No motor, sensory, reflex, trophic, vasomotor, electrical, visceral or X-ray disorders could be found.” The application of plaster corsets ‘cured’ this man’s deformity within six weeks.

      The poilus spoke of this condition as cintrage (arching), suggesting that it was not an uncommon affliction of the French soldier. Seemingly only recorded by French neurologists, Roussy and Lhermitte reported two subsequent cases.3 An infantryman was thrown into the air by the bursting of a shell, rendered unconscious and recovered experiencing violent pains in the back. He remained stooped to the right. His bent back was corrected by the application of plaster corsets. The other reported case was that of a chasseur who was buried in an explosion, knocked unconscious, and experienced acute respiratory distress, and subsequent mutism and camptocormia. One séance of electrical treatment corrected the improper attitude of the trunk, though he did continue to experience “a few persistent lumbar pains”.

      It would be difficult to doubt the probability that psychological factors influenced these men’s recuperation. To describe these soldiers as hysterical,1 though this was the terminology used during this period, or indeed that they suffered functional bent back, is probably unfair. They may well have suffered acute traumatic spinal injury and reactive muscle spasm (and contractures). Persistent stooping in shallow trenches, in appalling conditions of deprivation and danger, may have been contributing factors weakening the tone of paraspinal muscles. However, these case reports suggest that the traumatic injury alone may be sufficient explanation for the bent spines. The management of camptocormia in the first world war was to provide biomechanical supports, such as corsets, apparently with good results. The psychological therapies of “persuasive re-education” were additive rather than pivotal, and faradisation (and other tortures) used only “if necessary”.3

      The Sandler triad of low self esteem with confusion of identity, sadomasochistic behaviour toward military authorities, and impotence4 were, in 1947, proposed as being an essential part of camptocormia. Umapathi’s1 recognised causes of camptocormia and the contributing factors however implicate organicity, as indeed do the original case reports.

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      Author’s reply

      We would like to thank Dr J M S Pearce for his comments.

      We agree with him on the proliferation of medical terms referring to similar if not identical conditions. One of the chief aims of writing this paper is to thread a line of commonality through the various names in literature, which in essence refer to an anterior curvature of the spine. Hence the title “Head drop and camptocormia, the spectrum of bent-spine disorders”.

      However, we would like to disagree with Dr Pearce labelling the spinal deformity seen in ankylosing spondylitis as camptocormia. In arthritic conditions and diseases that affect bone, the spinal deformity is fixed. In the bent-spine disorders referred to in the paper, the deformity may reduce considerably or even disappear with change in position, for example when supine. We would therefore prefer to reserve the phrases head drop (used interchangeably with head ptosis) and camptocormia to neurological conditions that affect the strength or tone of the muscles controlling spinal posture.

      As aficionados of medical history, we very much enjoy Dr A D Macleod’s letter. We agree that organic factors might have contributed to the camptocormia in solders believed to have been suffering from hysteria. It would have not been unexpected for patients, like the man described by Southard with a bullet wound near the spine,1 to have developed spasm or even denervation of thoracic paraspinal muscles.

      Reference

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